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Home My WebLink About0080 SUOMI ROAD - Health (2) �`�-lam S M E A KEEPING YOU ORGANIZED No.103U 2453L MADE W USA GET ORGANIZED AT SMEAD.COM Fmm...I ......_ THE COMMONWEALTH OF MASSACHUSETTS E®ARD F HEA TH - . .OF..... . ......... ........... :L . ........_._y_'..................... Apphration for Miipviial Works Tonstrudijan Vamit Application is hereby, made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at ............e......................7..A p Loa on-Ad es or N� W .-. •- ..�. er_. .:. _. .JN(� - � + +y./- ddress ._o Al-�-S.� ..... ---... ............ 1►! Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ _Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons,-------.................... Showers — Cafeteria Q' Other fixtures ------------------------••--•----- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons ) Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area............_.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `-� Percolation Test Results Performed bY•--•-•--••-•-•-••-----•----•---•...............•-='----------..._......--- Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G%, Test Pit No. 2................minutes per inch Dept of Test Pit.... .............. Depth to ground water-.----__•-______--_____. •-•-------------------------- ------....--------...................----- ODescription of Soil........................................... Cam..% -------------------- ------- ........................................................... 0 ........................................................................................................................ ......... 11........................ U Nature of Repairs or Alterations—Answer v n applica le.__=._ _ 1_.�. _...._.. .. . ... ....... ................ - - Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in -F operation until a Certificate of Compliance has been is d by the board o . Ig ......................... ... ••-- ---------------------- Date Application Approved BY--------- .. -----• = �- ... . , .- ate Application Disapproved for the following reasons---------------------------------••--.....----•------------------------------------------------•-•-•---••--••---- .---•-•-•-••-------•----•...-•--••---•--....--•-•-•------•...............................•---....----------•---------------------------------------------------•------------•-----------•----------..... Date PermitNo......................................................... Issued........................................................ Date ----------------------- -- ------------------------------------------------- -------------- ------------- No.... + ...�.... Fim .............. $.... THE COMMONWEALTH OF MASSACHUSETTS E®A RD F H EA T 10 ....OF..... Alip iration fir Dispo-4al lViliks Tuttstrtrtion Vrrmit Application is hereby made for a Permit to Construct (1:; ) or Repair ( an IndividizalSewage Disposal' System at 1' ,,f > .... ............ ...�...t-• �......................................... -•--- ......... ----- Lo aion-Ad res or No.1 W .----.. �. .. .. 1.:�_:. er � Ins ale r Address Type of Build'n Size Lot............................Sq. feet U Dwelling,!/No.No. of Bedrooms__________________________________________-.Ex ansion Attic Garbage Grinder � g.. ., P ( ) g ( , ) Q, Other—Type of Building .....................:...... No. of persons—............................ Showers ( ) - Cafeteria ( ) Q' Other fixtures ------------------------- ...................................................... W Design Flow............................................gallons per person per day. Total daily flow..........................._................gallons. WSeptic Tank-Liquid capacity..._........gallons Length----------- Width................ Diameter................ Depth................ x Disposal Trench No..................... Width------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter..................... Depth below:inlet__:_................. Total_leaching area..................sq. ft. % Z Other Distribution box.( ) Dosing tank Percolation.Test Results Performed by........................................................................... Date..................................... •. aTest Pit No. 1................minutes per.inch Depth of Test Pit.................... Depth to ground water........................ r 4, Test-Pit No. 2................minutes per inch Deptl of Test Pit.... ............... Depth to ground water........................ P4 .......... .................... ODescription of Soil........................................... ._.. -- ......--------------......--- -----------------------•-----------------------------••---•--•-• •-••-•--•-•------- -- ,, U Nature of Repairs or Alterations—Answer w n a;llica le_. ... . . .1_.r'' .: _._. ... .. == '"aol -------••-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigred further agrees not to place the system in operation until a Certificate of Compliance has been is d by the' oard of hWlth. ...... Application Approved BY---...... .: ` +! '!/ate Application Disapproved for the f ollowring reasons: ---•----------------------------------------------------•-•-------------------------------•----••---•---•--- ............................................................................. Date Permit No. ....................................... Issued ` ...... {}' Date THE COMMONWEALTH OF MASSACHUSETTS F.i BOARD OF HEALTH , i r ............O F .. ................. ......... •� �rz�ifar��r �� l��t��t�trr T S I TO CER IF at t iyidual Sewage Disposal System constructed (-r) or Repaired ( ) by ............................= -:....... . .............•--•--------•-----..._.....------....--------•---...... t � nstailer . ' at ----- ...............................,............................... has been installed in accordance with the.provisions of rticle X{.; f The State Sanitary Cf�/cdtes desc 'bed in the application for Disposal Works,Construction Permit No..*... ... ... _.-___-:_• t. dated__.Q"� ,5:_ _____7 s...... THE ISSUANCE OF THIS CERTIFICATE,SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ":-. Inspector { M f b AC- K'..r ? r 4 _ ',ry .'�y,e Ck Y n�', 'F.. 4 f 1 F S`.{. i�,T��.C.t _ '"�. 4y.t t�.•. .._s.:4.._.fti3• ..<.>.... ....,. .. ., ... .._ .. ., ..... .>UYS°�:-��d+3�� .-�..wc..?«,>v..�.....`�,�'..zti....�'_._�_sc.«.1.,:t�.. ¢ »u '�� _3...�. THE COMMONWEALTH,-OF MASSACHUSETTS ARD O . k HEA_LTH a. ... . 4 y OF - v../ .:.. uts oil Permission is hereby granted...In t- . ........... - a ,....:.. ..:.._ to Cons ( ) ior( epair ( i ual Sewa a is osal System ..... ---- Street as shown on the application for Disposal Works Construction Per No. . / ed... 7. d.�@M Board of ealt y� DATE_....�'�.�."' li,�.rig /�....----'...:............................... _ -"FORM 1255 HOBBS & WARREN, INC., PUBLISHERS' - - J